Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques

OBJECTIVE: Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques. METHODS: A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified. RESULTS: An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (

Coronary artery fistula: Review of 54 cases from single center experience

Background: Demographic and clinical characteristics and angiographic findings of Turkish patients with coronary artery fistula have been investigated in this study and diagnostic tests and treatment methods used in these patients have also been evaluated in detail. Methods: We have examined the cardiac catheterization laboratory database retrospectively between March 2006 and July 2010. Among 49,567 patients, we have noted 60 patients diagnosed as coronary artery fistula. After coronary angiographic images were evaluated by two invasive cardiologists, 54 patients who had clear evidence of vessel of origin and drainage were included in the study. Results: A total of 54 (0.1%) patients with coronary artery fistula were noted. Mean age was 56.7 ± 10.7 years; 42 out of 54 patients had accompanying cardiac disorders. Patients’ complaints were directly associated with the presence of the fistula. Chest pain was the admission symptom in all of the patients with isolated coronary artery fistula. Six patients had coexistent congenital anomalies. Myocardial infarction with ST segment elevation occurred in 11 of the patients. In contrast to the previous reports, the most common artery of origin of the fistula was left anterior descending artery (50.8%) and pulmonary artery was found to be the most frequent region of the fistula drainage by 53.7%. Conclusions: Our findings suggest that large fistulas originating from the proximal segments of coronary arteries may increase the likelihood of atherosclerosis and myocardial infarction even in asymptomatic patients with no evidence of ischemia in noninvasive tests and no dilatation of cardiac chambers, and should therefore be closed

Combined past preeclampsia and gestational diabetes is associated with a very high frequency of coronary microvascular dysfunction

Background: A history of preeclampsia (pPE) and gestational diabetes (pGDM) are female-specific risk markers for atherosclerosis and future cardiovascular risk. In addition to increasing the risk of established risk factors for atherosclerosis, such as hypertension or diabetes, evidence suggests that pregnancy-related complications can also directly accelerate atherosclerosis by inducing endothelial dysfunction. A combination of both conditions is seen in a subset of patients with pregnancy, though it is not known whether this combination increases the overall risk for cardiovascular events. Aims: Present study aimed to find the impact of combined pPE/pGDM on the prevalence of coronary micro vascular dysfunction (CMD). Methods: A total of 24 patients with combined pPE/pGDM, 19 patients with isolated pPE and 63 patients with pGDM were included to the present study and a further 36 healthy women with no previous pregnancy-related complications served as controls. Coronary flow reserve was measured using echocardiography and CMD was defined as a coronary flow reserve <= 2.5. Results: Patients with combined pPE/pGDM had a high prevalence of CMD (91%), which was significantly higher than controls (5.6%, p < 0.001) and patients with pGDM (55%, p = 0.01). A history of pPE on top of pGDM was associated with an increased risk of CMD (HR:6.28, 95%CI:1.69-23.37, p = 0.006) after multivariate adjustment, but pGDM did not increase the odds for CMD in those with pPE. Conclusions: Combined pPE/pDM is associated with a very high prevalence of CMD, which may indicate an increased risk for future cardiovascular events.WOS:0006131998000152-s2.0-85096641950PubMed: 3318973

Does celiac disease impair coronary microvascular circulation: Coronary flow velocity reserve of patients with celiac disease

Background Celiac disease (CD) is an enteropathy characterized with immune reaction to gliadin protein. Aim In this study, we aimed to assess effect of CD on coronary microvascular circulation and the association between coronary flow velocity reserve (CFVR) and hs-CRP/Albumin ratio. Material and Methods Study was conducted between March 2017 and November 2018 with CD at Umraniye Training and Research Hospital Gastroenterology Clinic. CFVR was defined as the ratio of hyperemic to baseline diastolic peak velocities. CFVR >= 2.0 was considered normal. C-reactive protein/albumin ratio (CAR) was calculated as hs-CRP/albumin. Results Serum albumin (4.27 +/- 0.56 vs 4.50 +/- 0.34; P value: .04) level was significantly lower in celiac group but higher Hs-CRP (2.44 +/- 1.24 vs 1.82 +/- 1.29; P value < .01), hs-CRP/albumin ratio (0.57 +/- 0.30 vs 0.41 +/- 0.31; P value: .03) were recorded in celiac group. Both hyperemic flow and CFVR substantially lower in the celiac group compared to controls. In univariate analysis; age, hs-CRP, and hs-CRP/albumin ratio were associated with low CFVR and hs-CRP/albumin level was an accurate predictor of low CFVR at the ROC curve. Conclusion In this study, we found that in patients with CD, coronary flow reserve is impaired

Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques

OBJECTIVE: Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques. METHODS: A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified. RESULTS: An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p<0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p<0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p<0.001). The global longitudinal strain showed a significant increase after successful revascularization (p<0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction &#8805;50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement. CONCLUSIONS: Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium

Troponin and Anti-Troponin Autoantibody Levels in Patients with Ventricular Noncompaction

Ventricular hypertrabeculation/noncompaction is a morphologic and functional anomaly of myocardium characterized by prominent trabeculae accompanied by deep recessus. Dilated cardiomyopathy with left ventricular failure is observed in these patients, while the cause or pathophysiologic nature of this complication is not known. Anti-troponin antibodies are formed against circulating cardiac troponins after an acute coronary event or conditions associated with chronic myocyte necrosis, such as dilated cardiomyopathy. In present study, we aimed to investigate cardiac troponins and anti troponin autoantibodies in ventricular noncompaction/hypertrabeculation patients with/without reduced ejection fraction. A total of 50 patients with ventricular noncompaction and 23 healthy volunteers were included in this study. Noncompaction/hypertrabeculation was diagnosed with two-dimensional echocardiography using appropriate criteria. Depending on ejection fraction, patients were grouped into noncompaction with preserved EF (LVEF >50%, n = 24) and noncompaction with reduced EF (LVEF <35%, n = 26) groups. Troponin I, troponin T, anti-troponin I IgM and anti-troponin T IgM were measured with sandwich immunoassay method using a commercially available kit. Patients with noncompaction had significantly higher troponin I (28.98 +/- 9.21 ng/ml in NCNE group and 28.11 +/- 10.42 ng/ml in NCLE group), troponin T (22.17 +/- 6.97 pg/ml in NCNE group and 22.78 +/- 7.76 pg/ml in NCLE group) and antitroponin I IgM (1.92 +/- 0.43 mu g/ml in NCNE group and 1.79 +/- 0.36 mu g/ml in NCLE group) levels compared to control group, while antitroponin T IgM and IgG were only elevated in patients with noncompaction and reduced EF (15.81 +/- 6.52 mu g/ml for IgM and 16.46 +/- 6.25 mu g/ml for IgG). Elevated cardiac troponins and anti-troponin I autoantibodies were observed in patients with noncompaction preceding the decline in systolic function and could indicate ongoing myocardial damage in these patients

Zaburzenia przewodzenia przedsionkowego u chorych na łuszczycę zwyczajną

Background: Psoriasis vulgaris is one of the most common chronic inflammatory skin disorders. Patients with psoriasis are at risk of developing atrial fibrillation (AF). The electromechanical delay (EMD) is the time interval from the onset of the P wave on surface electrocardiography (ECG) to the beginning of the A wave. Prolonged atrial EMD is an independent risk factor for the development of AF. Aim: This study investigated the intra- and interatrial EMD in patients with psoriasis. Methods: This study included 85 adults with psoriasis vulgaris (Group 1) and 46 age- and sex-matched healthy individuals (Group 2). ECGs were obtained from all subjects, and atrial EMD variables were calculated. Results are reported as means ± standard deviations and percentages. Continuous variables were analysed using Student’s t-test. A p-value &lt; 0.05 was considered statistically significant. Results: Interatrial electromechanical delay (IA-EMD) and intra-left atrial electromechanical delay (ILA-EMD) were significantly longer in the psoriasis group compared with controls. A correlation analysis between psoriasis severity (PASI score) and the atrial conduction parameters revealed a significant positive correlation between PASI and IA-EMD (r = 0.261, p &lt; 0.001). In addition, there was a positive correlation between high-sensitivity C-reactive protein (hsCRP) and IA-EMD (p = 0.022). Conclusions: The atrial conduction time was longer in patients with psoriasis vulgaris and it correlated with the severity of disease and hsCRP. Since the association between delayed conduction and AF is known, the measurement of intra-atrial conduction times could be a practical tool to estimate the AF risk in these patients.Wstęp: Łuszczyca zwyczajna jest jedną z najczęstszych przewlekłych zapalnych chorób skóry. U pacjentów z łuszczycą występuje ryzyko migotania przedsionków (AF). Opóźnienie elektromechaniczne (EMD) to odstęp czasowy od początku załamka P w elektrokardiogramie (EKG) powierzchniowym do początku załamka A. Cel: W niniejszym badaniu oceniono wewnątrz- i międzyprzedsionkowe EMD u chorych na łuszczycę zwyczajną. Metody: Do badania włączono 85 dorosłych pacjentów z łuszczycą zwyczajną (Grupa 1) oraz 46 dopasowanych pod względem wieku i płci zdrowych osób (Grupa 2). U wszystkich uczestników wykonano badanie EKG I obliczono przedsionkowe zmienne EMD. Wyniki przedstawiono jako średnie ± odchylenie standardowe i wartości procentowe. Do analizy zmiennych ciągłych zastosowano test t Studenta. Wartość p &lt; 0,05 przyjęto za istotną statystycznie. Wyniki: Międzyprzedsionkowe opóźnienie elektromechaniczne (IA-EMD) i opóźnienie elektromechaniczne w obrębie lewego przedsionka (ILA-EMD) były istotnie dłuższe w grupie chorych na łuszczycę niż w grupie kontrolnej. Analiza korelacji między stopniem ciężkości łuszczycy (skala PASI) a parametrami przewodzenia przedsionkowego wykazała istotną dodatnią korelację między PASI a IA-EMD (r = 0,261; p &lt; 0,001). Ponadto stwierdzono dodatnią korelację między stężeniem białka C oznaczanego metodą wysokoczułą (hsCRP) a IA-EMD (p = 0,022). Wnioski: U pacjentów z łuszczycą zwyczajną czas przewodzenia przedsionkowego był dłuższy i korelował ze stopniem ciężkości choroby oraz stężeniem hsCRP. Z uwagi na to, że związek między opóźnieniem przewodzenia i AF jest znany, pomiar czasu przewodzenia wewnątrzprzedsionkowego mógłby być praktycznym narzędziem służącym do oceny ryzyka AF u tych chorych

Does celiac disease impair coronary microvascular circulation: Coronary flow velocity reserve of patients with celiac disease

Background Celiac disease (CD) is an enteropathy characterized with immune reaction to gliadin protein. Aim In this study, we aimed to assess effect of CD on coronary microvascular circulation and the association between coronary flow velocity reserve (CFVR) and hs-CRP/Albumin ratio. Material and Methods Study was conducted between March 2017 and November 2018 with CD at Umraniye Training and Research Hospital Gastroenterology Clinic. CFVR was defined as the ratio of hyperemic to baseline diastolic peak velocities. CFVR >= 2.0 was considered normal. C-reactive protein/albumin ratio (CAR) was calculated as hs-CRP/albumin. Results Serum albumin (4.27 +/- 0.56 vs 4.50 +/- 0.34; P value: .04) level was significantly lower in celiac group but higher Hs-CRP (2.44 +/- 1.24 vs 1.82 +/- 1.29; P value < .01), hs-CRP/albumin ratio (0.57 +/- 0.30 vs 0.41 +/- 0.31; P value: .03) were recorded in celiac group. Both hyperemic flow and CFVR substantially lower in the celiac group compared to controls. In univariate analysis; age, hs-CRP, and hs-CRP/albumin ratio were associated with low CFVR and hs-CRP/albumin level was an accurate predictor of low CFVR at the ROC curve. Conclusion In this study, we found that in patients with CD, coronary flow reserve is impaired